Lege Artis Medicinae

[Antiplatelet therapy with acetylsalicylic acid - Cardiovascular indications and haemorrhagic complications]

KISS Nóra1, KISS Róbert Gábor1

FEBRUARY 20, 2010

Lege Artis Medicinae - 2010;20(02)

[Acetylsalicylic acid effectively blocks the activation of platelets, and becomes a basic element of antithrombotic therapy of patients with high cardiovascular risk. Decrease of platelet reactivity is due to the irreversible inhibition of COX- 1 isoenzime in platelets during treatment. Choosing the right dose is still not an easy task. Bleeding side effects are frequently seen in patients treated with this drug worldwide. Clinical benefit does not improves with escalated doses (300 mg), however the risk of haemorrhagic events increases. Therefore acetylsalicylic acid dose should be reduced to the effective minimal dose (75-150 mg daily) after the acute phase of atherothrombosis in order to prevent side effects. Effect of acetylsalicylic acid differs individually, it might be important screening out those patients who respond less to the drug. Resistance is still an evolving field, proper methodology is to be determined. Right indications of acetylsalicylic acid needs balance between reaching clinical benefit and avoiding side effects. The Hungarian Cardiovascular Therapeutic Consensus Conference 2009 suggested acetylsalicylic acid in primary prevention for those males only, who have overt cardiovascular risk, and SCORE result is more than 10%, with no gastrointestinal haemorrhage in medical history, and with a well-controlled hypertension. Lifelong aspirin prevention should be used after all diagnosed cardiovascular atherothrombotic event as a cornerstone of secondary prevention with low dose (75-150 mg daily) in both genders.]

AFFILIATIONS

  1. HM Állami Egészségügyi Központ, MTA-SE Gyulladásbiológiai és Immungenomikai Kutatócsoport

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[The significance of media literacy in adolescent smoking and drinking]

PIKÓ Bettina, BALÁZS Máté Ádám, PAGE M. Randy

[INTRODUCTION - Media exerts a strong socialization effect on adolescents who are particularly susceptible to different messages in this life period. In the present study, therefore, we focused on adolescents’ media literacy. METHODS - 546 adolescents from Makó (Southern Hungary) were studied, including 288 (52.7%) grade 8 (age 13-15 years) and 258 (47.3%) grade 12 (age 17-19 years) students; 49.5% of the participants were male and 50.5% female. The survey covered sociodemographic variables, lifetime and monthly prevalence of smoking and drinking, attitudes related to substance use and media literacy. For the study of media literacy, we adapted a Medica Literacy Scale containing 31 items. After performing factor analysis, factors of media literacy were analyzed by two-sample t-tests according to sociodemographic variables and behaviour. RESULTS - Our results show that factors of media literacy are well differentiated according to sociodemographic variables and even more according to smoking and drinking behaviour. Girls and younger adolescents (among who substance use is less frequent) are more likely to notice the hidden messages of substance use that are shown in advertisements and movies, and the representation of the interests of the tobacco and alcohol industry in the media. Nonsmokers and nondrinkers are a lot more aware of the manipulation effects of the media. CONCLUSIONS - Our results draw attention to the significance of media literacy in the prevention of adolescent smoking and drinking.]

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[Dangers of the use of performance enhancement drugs and food supplements]

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[The history of humankind is full of stories related to performance enhancement drug abuse. For the purpose of improving explosive power and long-term physical performance central nervous system stimulating drugs and supplements, such as: amphetamine and cocaine have been used. Androgenic anabolic steroids are used for increasing skeletal muscle mass. The abuse of performance enhancer drugs is seriously deteriorating the human health, and have several negative side effects. Number of food-supplements - available in the market, often contain traces of steroids. So called designer steroids are extremely dangerous. In the near future it will be possible to enhance physical performance through genetic interventions.]

Lege Artis Medicinae

[Heart surgery among octogenerians - fiction or reality?]

SZÉKELY László, GYÖRGY Margit, JUHÁSZ Boglárka, SZABÓ J. Zoltán, SZUDI László, PAULOVICH Erzsébet, LONKAY Eszter, HORKAY Ferenc

[OBJECTIVE - Aging of the society results in important demographic changes in cardiac surgical practice. Controversy exists as to whether heart surgery in elderly patients improves their life expectancy and the severe functional restraint caused by their heart diseases. PATIENTS AND METHODS - We discuss a retrospective study of octogenarian patients who underwent cardiac surgical procedures in our institutions between 01.01.2000. and 30.06.2006. The mean age of the 105 participants was 81.5 years (80-87). 67% (70) of patients had coronary artery disease (CAD). 31% (33) of the patients had aortic valve stenosis (AVR), of whom 16 had isolated AVR and 17 had AVR combined with CAD. One patient had surgery because of mitral valve insufficiency (MVR) only, and one was treated for combined AVR and MVR. The average surgical euroscore was 9.7 (5-18) and the predictive mortalities were 18%. 9.5% of the procedures were acute, 42.9% were urgent and 47.6% were chronic surgeries. RESULTS - The average operating time was 149±23 min, duration of the aortic cross clamp was 65±11 min. OPCAB procedures were performed in 82.9% of patients treated for CAD. In the postoperative period, the occurrence of renal failure was 2.9%, blood transfusions were needed in 37.4% of patients, and neurological deficits occurred in 2.9% of patients. The incidence of perioperative myocardial infarction was 5.6%. The rate of early mortality was 4.8%, the rate of late (>30 days) mortality was 14.3%. At the last follow-up examination, 67 (79%) of the surviving 85 patients were free of cardiac symptoms, physically active and able to take care of themselves. 14 patients (17%) needed some help and only 4 patients (5%) were unable of taking care of themselves. CONCLUSIONS - The mortality of cardiac diseases can be reduced by cardiac surgeries in octagenerians. Improvement of cardiac symptoms improves the patients’ functional status and their quality of life can be similar to that of healthy people of the same age.]

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[Blood pressure management for stroke prevention and in the acute stroke. The new guideline of European Society of Hypertension (ESH, 2018), European Society of Cardiology and Hungarian Society of Hypertension (HSH, 2018)]

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[Hypertension is the leading modifiable risk factor for stroke. Its prevalence amongst stroke patient is about 60-70% and the benefit of blood pressure (BP) lowering therapy on stroke risk reduction is well established. However the optimal BP targets for preventing stroke and reducing stroke consequences have been controversial. The new European (ESC/ESH) and Hungarian (HSH) hypertension guideline published in 2018 highlighted the primary and secondary prevention of stroke and the BP management in the acute stroke care as well. According results from ACCORD, SPRINT, HOPE-3, and other metaanalysis the systolic blood pressure (SBP) lowering < 120 mmHg has not favourable effect, thus in hypertensive patients < 65 years the SBP should be lowered to a BP range of 120-129 mmHg. In older patients ≥ 65 years the SBP should be targeted to a BP range of 130-139 mmHg (IA). In patients with acute intracerebral haemorrhage careful acute BP lowering with iv. therapy, to <180 mmHg should be considered only in case of SBP ≥ 220 mmHg (IIaB). In patients with acute ischaemic stroke who are eligible for iv. thrombolysis, BP should be carefully lowered and maintained to < 180/105 mmHg for at least the first 24 h after thrombolysis (IIaB). If the patient is not eli gible for lysis and BP ≤ 220/110 mmHg, routine BP lowering drug therapy is not recommended inside 48-72 h (IA). In patients with markedly elevated BP > 220/110 mmHg who do not receive fibrinolysis, drug therapy may be considered, based on clinical judgement, to reduce BP by 15% during the first 24 h after the stroke onset (IIbC). After 72 h of acute stroke in case of hypertensive patients < 65 years the SBP should be lowered to a BP range of 120-129 mmHg (IIaB). In older patients ≥ 65 years the SBP should be targeted to a BP range of 130-139 mmHg (IA). If BP < 140/90 mmHg after stroke, the BP lowering should be considered (IIbA). It is recommended to initiate an antihypertensive treatment with combination, preferably single pill combination of renin-angiotensin system blockers plus a calcium channel blocker and/or a thiazide like diuretics (IA). Lowering SBP < 120 mmHg is not recommended due to advers events regardless of age and type of stroke either in primary or secondary stroke prevention.]

Lege Artis Medicinae

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[Since its synthesis more than 100 years ago aspirin has become one of the most successful drug. Low-dose, long-term aspirin therapy reduces the risk of myocardial infarction, the frequency of cerebral stroke and also reduces the mortality of peripheral arterial diseases and systemic embolisms. With aspirin therapy becoming more and more widespread current knowledge is also getting more concerned about the gastrointestinal risks and beneficial effects. Aspirin therapy causes gastrointestinal damages by the inhibition of endogenous prostaglandin synthesis. The ion trapping effect and the injury of mucosal barrier as well as the inhibition of platelet aggregation are also responsible for gastrointestinal damages. According to epidemiological studies lowdose aspirin treatment increases the risk of acute upper gastrointestinal bleeding by 1.5-2.0 fold. However, endoscopic studies indicate that gastroduodenal ulcers may develop even in 10 percent of cases on long term aspirin treatment, most frequently in a symptom-free form. Older age as well as Helicobacter pylori infection increase the risk of aspirin induced ulcers. Beside Helicobacter pylori eradication therapy, preventive proton-pump-inhibitor treatment and the widespread of new non-toxic aspirin derivates may decrease the risk of gastrointestinal complications. Capsule endoscopy also seems to be a promising diagnostic tool for detecting aspirin induced small bowel erosions and ulcers. Long-term aspirin treatment increases the risk of acute bleeding from large bowel diverticulas especially with non-steroidal anti-inflammatory drug co-therapy present. Long-term, low-dose aspirin treatment is a promising method for the chemoprevention of colorectal cancers.]

Lege Artis Medicinae

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Lege Artis Medicinae

[Written and pictorial content in magazines and their possible relationship to eating disorders]

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[Various medical associations issue different recommendations for the prevention and treatment of vitamin D deficiency. These significant differences are partly explained by the different definition of normal vitamin D level and the use of completely different mathematical models to predict the increase in vitamin D level as a response to therapy. According to the Institute of Medicine, the target vitamin D level is 20 ng/ml, whereas the Endocrine Society recommends 30 ng/m as the minimum target value. These differences show that the two Society have different views on the risk of adverse effects. Screening, however, is not recommended by either society. In this review I summarize the role of the vitamin D supplementation in the prevention of infertility. Also, I suggest the protective effect of the vitamin D during the pregnancy. In my opinion screening program against D hypovitaminosis should be performed in case of infertility and in pregnancy, because data show a protective role of vitamin D against many disease of newborn. ]